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Public hospitals the only choice if you’re very sick, very young or old, or live in rural areas

Tuesday, December 5, 2017

‘A new report released today by the Australian Institute of Health and Welfare shows that if you’re very sick, very young or very old, or live in rural areas, and you want to use your private health insurance and choose your doctor, public hospitals are your only real choice’, said Dr Linc Thurecht, Australian Healthcare and Hospitals Association (AHHA) Senior Research Director.

‘For people in rural and regional areas of Australia it can be difficult, and sometimes impossible, for patients to access private hospitals. The only way to have a doctor of your own choice is to use private health insurance in a public hospital. This is evident in the data reported today, which show that the proportion of private health insurance funded separations that occurred in public rather than private hospitals increased with increasing remoteness (31% of separations of people living in remote areas, compared with 17% for people living in major cities).

‘Likewise for many patients with serious medical conditions requiring services that may not be available in private hospitals, their right to choice of a doctor is exercised in a public hospital using their private insurance. This is particularly the case for very ill children for whom almost all care is provided in public hospitals. Women’s and children’s public hospitals are reported as having the highest proportion (17%) of private health insurance funded separations. Parents wanting to exercise their right to choose their child’s doctor will use their private health insurance to do so—this should not be considered unreasonable.

‘The data also show that patients with chronic conditions such as kidney disease and diabetes, who may have been treated by private specialists for years, are using their private insurance in public hospitals. Continuity of care is important, and should be respected by policy makers and insurers. Data about the funding sources for dialysis and rehabilitation demonstrate this.

‘Much hullabaloo has been made about privately insured patients getting quicker access to care in public hospitals; however the data clearly show that those patients being funded by insurers in public hospitals for elective surgery were more likely to be in category 1 for clinical urgency (needing surgery within 30 days), and not surprisingly this was in highly complex areas of care which are often provided in large public teaching hospitals, such as neurosurgery.

‘Any inference that this might be a form of queue-jumping is highly offensive to public hospital clinicians who are bound not only by their professional ethics but also by hospital and state health department requirements to ensure people receive care on the basis of clinical urgency and need.

‘There are several clinical areas where public hospitals are the main provider of care, to both public patients and privately insured patients, because of the complexity of health care services required—for example, palliative care (71%), extensive burns (86%) and transplants (86%). That 70% of emergency admissions funded by private health insurance occur in public hospitals is also not surprising, given that almost all emergency care in Australia is provided in public hospitals.

‘A major gap in the data, as acknowledged in the report, is that private health insurance coverage (and use in hospitals) cannot currently be disaggregated by the types of hospital cover policies available. This is a significant gap—as the report also notes there are four types of hospital policies, three of which have exclusions, and one of which provides cover only for use in public hospitals.

‘As long as private health insurers continue to market products which promote the use of private health insurance in public hospitals, and governments continue to permit this, there should be no surprise that people who purchase these products want to exercise their right to claim against them’, said Dr Thurecht.